Waiting time reduction in intravitreal clinics by optimization of appointment scheduling: balancing demand and supply.
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ABSTRACT:
SUBMITTER: Ugarte M
PROVIDER: S-EPMC4695962 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Outpatient Chemotherapy Appointment (OCA) planning and scheduling is a process of distributing appointments to available days and times to be handled by various resources through a multi-stage process. Proper OCAs planning and scheduling results in minimizing the length of stay of patients and staff overtime. The integrated consideration of the available capacity, resources planning, scheduling policy, drug preparation requirements, and resources-to-patients assignment can improve the Outpatient Chemotherapy Process's (OCP's) overall performance due to interdependencies. However, developing a comprehensive and stochastic decision support system in the OCP environment is complex. Thus, the multi-stages of OCP, stochastic durations, probability of uncertain events occurrence, patterns of patient arrivals, acuity levels of nurses, demand variety, and complex patient pathways are rarely addressed together. Therefore, this paper proposes a clustering and stochastic optimization methodology to handle the various challenges of OCA planning and scheduling. A Stochastic Discrete Simulation-Based Multi-Objective Optimization (SDSMO) model is developed and linked to clustering algorithms using an iterative sequential approach. The experimental results indicate the positive effect of clustering similar appointments on the performance measures and the computational time. The developed cluster-based stochastic optimization approaches showed superior performance compared with baseline and sequencing heuristics using data from a real Outpatient Chemotherapy Center (OCC).
| S-EPMC9736607 | biostudies-literature
Project description:Approximately half of first opinion, small animal consultations exceed their allocated time and there's a growing call in the UK for longer consults. The aim of this study was to investigate and describe allocated appointment length in first opinion, small animal practice in the UK. Almost half (49.8%) of consults were scheduled for 15 min, with a further 39.4% scheduled for 10 min. Nearly all participants (97.1%) reported flexibility when booking appointments, scheduling longer appointments for conditions predicted to require more time. However, the majority (68.1%) reported no additional cost charged to the client for a longer consult. Furthermore, 54.7% of the survey respondents offered nurse appointments free of charge. A restructured approach to consult scheduling for both Veterinary Surgeon and Registered Veterinary Nurse (RVN) consultations could help to improve workforce wellbeing, utilise the vast knowledge and skill sets of RVNs and improve financial metrics.
| S-EPMC6820084 | biostudies-literature
Project description:BackgroundPatient access to care and long wait times has been identified as major problems in outpatient delivery systems. These aspects impact medical staff productivity, service quality, clinic efficiency, and health-care cost.ObjectivesThis study proposed to redesign existing patient types into scheduling groups so that the total cost of clinic flow and scheduling flexibility was minimized. The optimal scheduling group aimed to improve clinic efficiency and accessibility.MethodsThe proposed approach used the simulation optimization technique and was demonstrated in a Primary Care physician clinic. Patient type included, emergency/urgent care (ER/UC), follow-up (FU), new patient (NP), office visit (OV), physical exam (PE), and well child care (WCC). One scheduling group was designed for this physician. The approach steps were to collect physician treatment time data for each patient type, form the possible scheduling groups, simulate daily clinic flow and patient appointment requests, calculate costs of clinic flow as well as appointment flexibility, and find the scheduling group that minimized the total cost.ResultsThe cost of clinic flow was minimized at the scheduling group of four, an 8.3% reduction from the group of one. The four groups were: 1. WCC, 2. OV, 3. FU and ER/UC, and 4. PE and NP. The cost of flexibility was always minimized at the group of one. The total cost was minimized at the group of two. WCC was considered separate and the others were grouped together. The total cost reduction was 1.3% from the group of one.ConclusionsThis study provided an alternative method of redesigning patient scheduling groups to address the impact on both clinic flow and appointment accessibility. Balance between them ensured the feasibility to the recognized issues of patient service and access to care. The robustness of the proposed method on the changes of clinic conditions was also discussed.
| S-EPMC4817334 | biostudies-literature
Project description:The mTORC1-signaling pathway integrates environmental conditions into distinct signals for cell growth by balancing anabolic and catabolic processes. Accordingly, energetic stress inhibits mTORC1 signaling predominantly through AMPK-dependent activation of TSC1/2. Thus, TSC1/2-/- cells are hypersensitive to glucose deprivation, and this has been linked to increased p53 translation and activation of apoptosis. Herein, we show that mTORC1 inhibition during glucose deprivation prevented not only the execution of death, but also induction of energetic stress. mTORC1 inhibition during glucose deprivation decreased AMPK activation and allowed ATP to remain high, which was both necessary and sufficient for protection. This effect was not due to increased catabolic activities such as autophagy, but rather exclusively due to decreased anabolic processes, reducing energy consumption. Specifically, TSC1/2-/- cells become highly dependent on glutamate dehydrogenase-dependent glutamine metabolism via the TCA cycle for survival. Therefore, mTORC1 inhibition during energetic stress is primarily to balance metabolic demand with supply.
| S-EPMC2896794 | biostudies-literature
Project description:In recent years, the environmental problems caused by excessive carbon emissions from energy sources have become increasingly serious, which not only aggravates the climate change caused by the greenhouse effect but also seriously restricts the sustainable development of Chinese economy. An attempt is made in this paper to use energy consumption method and input-output method to study the carbon emission structure of China's energy system and industry in 2015 from two perspectives, namely China's energy supply side and energy demand side, by taking into account the two factors of energy invest in gross capital formation and export. The results show that neglecting these two factors will lead to underestimation of intermediate use carbon emissions and overestimation of final use carbon emissions. On energy supply side, the carbon emission structure of China's energy system is still dominated by high-carbon energy (raw coal, coke, diesel, and fuel oil, etc.), accounting for more than 70% of total energy carbon emissions; on the contrary, the natural gas such as clean energy accounts for only 3.45% of total energy carbon emissions, indicating that the energy consumption structure optimization and emission reduction gap of China's energy supply side are still substantial. On energy demand side, the final use (direct consumption by residents and government) produces less carbon emissions, while the intermediate use (production by enterprises) produces more than 90% of the total energy carbon emissions. Fossil energy, power sector, heavy industry, chemical industry, and transportation belong to industries with larger carbon emissions and lower carbon emission efficiency, while agriculture, construction, light industry, and service belong to industries with fewer carbon emissions and higher carbon emission efficiency. This means that the optimization of industrial structure is conducive to slowing down the growth of energy carbon emissions on the demand side.
| S-EPMC7537888 | biostudies-literature
Project description:BackgroundIntegrated dental services within the Health System, particularly at primary health care, are crucial to reverse the current impact of oral diseases, which are among the most prevalent diseases worldwide. However, the use of dental services is determined by complex phenomena related to the individual, the environment and practices in which care is offered. Therefore, factors associated with dental appointments scheduling can affect positively or negatively the use of dental services. The aim of the present study was to evaluate the indicators for dental appointment scheduling in Primary Health Care (PHC).MethodsThe present is a cross-sectional analytical study that used data from the external assessment of the third cycle of the National Program for Improving Access and Quality in Primary Care (PMAQ-AB), carried out between 2017 and 2018, in Brazil. The final sample consisted of 85,231 patients and 22,475 Oral Health teams (OHTs). The outcome variable was the fact that the user sought for a dental appointment at the Primary Health Care Unit. A multilevel analysis was carried out to verify the association between individual variables (related to users) and contextual variables (related to the OHTs) in relation to the outcome.ResultsOnly 58.1% of the users interviewed at these Primary Health Care Units seek the available dental care. The variables with the greatest effect on the outcome were the patient's age up to 42 years old (OR = 2.03, 95% CI: 1.96-2.10), at individual level, and 'oral health teams that assisted no more than a single family health team (FHT)' (OR = 1.29, 95% CI: 1.23-1.36) at contextual level. Other variables were also associated with the outcome, but with a smaller effect size.ConclusionIn conclusion, users' age and work process of OHT were indicators for dental appointment scheduling. Our results suggest that when OHT put the National Oral Health Policy guidelines into practice, by assisting only one FHT, the chance for PHC users seeking dental appointments is higher than OHTs that assist more than one FHT. Regarding age, patients aged up to 42 years are more likely to seek an appointment with a dentist.
| S-EPMC8656053 | biostudies-literature
Project description:BackgroundCost-sharing in health insurance plans creates incentives for patients to shop for lower prices, but it is unknown what price information patients can obtain when scheduling office visits.ObjectiveTo determine whether new patients can obtain price information for a primary care visit and identify variation across insurance types, offices, and geographic areas.DesignSimulated patient methodology in which trained interviewers posed as non-elderly adults seeking new patient primary care appointments. Caller insurance type (employer-sponsored insurance [ESI], Marketplace, or uninsured) and plan were experimentally manipulated. Callers who were offered a visit asked for price information. Unadjusted means and regression-adjusted differences by insurance, office types, and geography were calculated.ParticipantsCalls to a representative sample of primary care offices in ten states in 2014: Arkansas, Georgia, Iowa, Illinois, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas (N = 7865).Main measuresCallers recorded whether they were able to obtain a price. If not, they recorded whether they were referred to other sources for price information.Key resultsOverall, 61.8% of callers with ESI were able to obtain a price, versus 89.2% of uninsured and 47.3% of Marketplace callers (P < 0.001 for differences). Price information was also more readily available in small offices and in counties with high uninsured rates. Among callers not receiving a price, 72.1% of callers with ESI were referred to other sources (billing office or insurance company), versus 25.8% of uninsured and 50.9% of Marketplace callers (P < 0.001). A small fraction of insured callers were told their visit would be free. If not free, mean visit prices ranged from $157 for uninsured to $165 for ESI (P < 0.05). Prices were significantly lower at federally qualified health centers (FQHCs), smaller offices, and in counties with high uninsured and low-income rates.ConclusionsPrice information is often unavailable for privately insured patients seeking primary care visits at the time a visit is scheduled.
| S-EPMC5481227 | biostudies-literature
Project description:A questionnaire was developed to evaluate the journey experienced by patients from identifying a need to see a community specialist in Israel's public healthcare system, through scheduling an appointment and attending. A telephone survey was conducted with a nationally representative group of 3751 adults, in 2019 to 2020. Fifty-seven percent needed to see a specialist in the last 6 months; among those, 82%, visited a specialist. Among the 3% who did not make an appointment, in 41 of 52 (79%) cases this was due to long waiting time. Younger and more educated patients were more likely to try to get an earlier appointment. Timeliness (55%) and wanting a specific physician (43%) were major considerations in scheduling. Reported need was greater in females, Jewish versus Arab respondents, more educated and those with chronic illness. Those who did not make an appointment sought private care, emergency treatment, or went untreated. Although a large percentage of respondents did eventually get an appointment, vulnerable patients may have more difficulty navigating the system. Following the patient journey can provide insights to help design services better suited to patients' needs.
| S-EPMC9006356 | biostudies-literature
Project description:This paper addressed a scheduling problem which handles urgent tasks along with existing schedules. The uncertainties in this problem come from random process of existing schedules and unknown upcoming urgent tasks. To deal with the uncertainties, this paper proposes a stochastic integer programming (SIP) based aggregated online scheduling method. The method is illustrated through a study case from the outpatient clinic block-wise scheduling system which is under a hybrid scheduling policy combining regular far-in-advance policy and the open-access policy. The COVID-19 pandemic brings more challenges for the healthcare system including the fluctuations of service time and increasing urgent requests which this paper is designed for. The schedule framework designed in the method is comprehensive to accommodate various uncertainties in the healthcare service system, such as: no-shows, cancellations and punctuality of patients as well as preference of patients over time slots and physicians. Supplementary Information The online version contains supplementary material available at 10.1007/s43069-021-00089-6.
| S-EPMC8390183 | biostudies-literature
Project description:Abstract During the COVID‐19 pandemic, online appointment‐scheduling systems have become standard procedure in blood donation practice. This study develops and empirically tests a comprehensive conceptual model of blood donors' usage intentions of a donation appointment‐scheduling system during the COVID‐19 pandemic. Online survey data are collected from blood donors (n = 3269) and analyzed using the partial least squares structural equation modeling (PLS‐SEM) approach. The results provide evidence that intentions to use the system in the post‐COVID‐19 future are high. Together with high‐perceived usefulness and ease of use, this indicates generally high‐system acceptance among active donors during the pandemic and beyond. The study identifies a number of factors that influence this acceptance. The results show that different aspects of service quality perceptions in the context of the system drive its acceptance. The strongest positive effect is exerted by blood donors' pre‐donation planning convenience, followed by an enhanced actual donation experience. Reduced flexibility as a result of the system has a strong negative effect. The authors derive managerial implications for blood donation services regarding preserving the acceptance level and suggest future research prospects.
| S-EPMC9347690 | biostudies-literature